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Old 13.08.2015, 20:43
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Krankenkasse denying sick leave payment

Hi fellow members

I am unable to find a rule or an article about an employer deciding to withhold pay because the sick leave is a result of complications from aesthetic surgery.

they initiated, together with Swica, some sort of sick leave investigation and have sent a pay slip for July as 31 days of "unpaid leave" so it has 4400 CHF brutto and underneath -4440 for unpaid leave, zeroing out the paycheck.


The actual plastic surgery took place during a mutually agreed 2 weeks of unpaid leave but the wounds would not heal and she got in a bad state where a second operation was required. From this one, she also would not heal properly.Her hausarzt wrote an Arztzeugnis for whole August (issueing one week by week) but now they just simply decided to book the whole of July as unpaid leave claiming they are allowed not to pay until Swica conducts their investigation.
She also got fired per 30th September but she is not disputing that as she knows the law says you can be fired after 30 days of sickness if you are in your first year yet.

Anyone heard of a similar story before or know the actual regulation about this?


thanks in advance.
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Old 13.08.2015, 20:57
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Re: Krankenkasse denying sick leave payment

When there is prolonged absence from work, and you are only in your first year of work, there is a limit to how much sick leave the employer pays for. After that, there may be a gap of days before the sick leave insurance for extended illness comes into place.

A good starting point would be the treating doctor. They should be much clearer about the rules and paperwork needed (assuming the treating doctor is withint Switzerland)...

Given that the employee took 'unpaid leave' in order to undertake the surgery, the employer may be well in their rights to extend that for the duration of the illness...the number of 'sick' days counts consecutively for a single illness, and she may not be entitled to any paid sick leave anyway...

Given that the person now does not have a work contract, they should contact the unemployment services. If there is a lack of clarity, they will normally sort it out as they will only want to pay the minimum...

It would be worth asking the employer why they will not pay sick leave, and to clarify the rules...it is normal for the employer to withhold payment if the healh insurance has not paid it either...usually that starts with the employee providing all the correct paperwork, the insurance informing the employer what they will pay and then the employer will release the funds less tax to the employee.

There may be more than one insurer involved... The employee's normal health insurance, accident insurance, and the employer's insurance for extended sick leave...
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Old 13.08.2015, 21:07
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Re: Krankenkasse denying sick leave payment

Was the plastic surgery the result of an accident or elective treatment?
If it was elective I don't think they will call what happened an illness, just a complication of something you voluntarily chose to do.

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Hi fellow members

I am unable to find a rule or an article about an employer deciding to withhold pay because the sick leave is a result of complications from aesthetic surgery.

they initiated, together with Swica, some sort of sick leave investigation and have sent a pay slip for July as 31 days of "unpaid leave" so it has 4400 CHF brutto and underneath -4440 for unpaid leave, zeroing out the paycheck.


The actual plastic surgery took place during a mutually agreed 2 weeks of unpaid leave but the wounds would not heal and she got in a bad state where a second operation was required. From this one, she also would not heal properly.Her hausarzt wrote an Arztzeugnis for whole August (issueing one week by week) but now they just simply decided to book the whole of July as unpaid leave claiming they are allowed not to pay until Swica conducts their investigation.
She also got fired per 30th September but she is not disputing that as she knows the law says you can be fired after 30 days of sickness if you are in your first year yet.

Anyone heard of a similar story before or know the actual regulation about this?


thanks in advance.
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Old 13.08.2015, 21:31
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Re: Krankenkasse denying sick leave payment

Thank you, well she still is on her Kundigungszeit until the 30th September so the work contract is still "alive".

This was elective cosmetic surgery but the complications include heavy bleeding, pus, fever, etc so she is indeed incapable of work.

I have seen her contract. It says that 31 days is paid on 88% be the employer and another 780 days at max by Swica. Given that she was already sick 11 days between Januar and 30th June, this July absence was expected to be paid 20 days by employer and 11 days by Swica.


The doctor told us he was indeed investigated 2 weeks ago but all he did was supply all the medically correct information to the man from
Swica who visited him.
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Old 13.08.2015, 21:33
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Re: Krankenkasse denying sick leave payment

Well if you have a snowboard accident you also voluntarily choose to do something risky... it's a thin line isn't it?
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Old 13.08.2015, 21:44
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Re: Krankenkasse denying sick leave payment

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Well if you have a snowboard accident you also voluntarily choose to do something risky... it's a thin line isn't it?
That's an accident not something you chose to do with the associated risks


Fairly chunky size line
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Old 13.08.2015, 22:16
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Re: Krankenkasse denying sick leave payments

We found this though:

" Erfolgt eine Behandlung lediglich um dem Schönheitswahn der heutigen Zeit zu entsprechen, so hat der Arbeitneh- mer den Lohnausfall selber zu tragen. Liegt eine entsprechend schwerere Unregelmässigkeit vor, so ist die Arbeitsunfähigkeit eher krankheitsbedingt und fällt unter Art. 324a OR. Allerdings ist es möglich, dass eine Schönheitsoperation, welche ohne medizi- nische Indikation vorgenommen worden ist, zu Komplikationen führt, die ihrerseits Krankheitswert haben, so dass unter Umständen dennoch Lohnfortzahlungs- pflicht

The way I interpret the last sentence is that if the surgery leads to complications that have "illness value" per se, they still may have to pay. I guess it's down to how the doctor describes the whole thing then...
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Old 13.08.2015, 22:33
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Re: Krankenkasse denying sick leave payment

Were did the operation take place? And did a Swiss doctor refer the person to a specialist here?
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Old 13.08.2015, 23:12
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Re: Krankenkasse denying sick leave payment

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Well if you have a snowboard accident you also voluntarily choose to do something risky... it's a thin line isn't it?
There was no accident, you took a risk after being told about possible complications & signing a consent form. No insurance will include this at standard rates it's a specialised additional risk.
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Old 13.08.2015, 23:42
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Re: Krankenkasse denying sick leave payment

Oh, I explained her she should have saved enough money not just for the surgery itself, but anything that may follow including worst case consequences. Like long term health damage etc. She didn't and now come the rent problems.

An interesting take on the topic is this:
http://www.parlament.ch/d/suche/seit...ch_id=20123246

where a motion about total refusal of complication costs was rejected, and it says this

"Die Frage, ab wann eine versicherte Person ein Verschulden für einen Gesundheitsschaden trägt, ist auch unter dem Gesichtspunkt der Ethik sehr heikel. Zudem gibt es zahlreiche weitere Verhaltensweisen und als Risiken geltende Tätigkeiten, die gesundheitsschädigende Auswirkungen haben können. Es ist somit sachlich und mit Blick auf den Grundsatz einer rechtsgleichen Behandlung nicht zu begründen, nur Folgebehandlungen von nicht kassenpflichtigen kosmetischen Eingriffen von der Leistungspflicht auszunehmen."

Luckily she has legal insurance and contacted them (they said they will answer next week), we were simply trying to find someone who actually knows about such a case or has a legal background. Her German is not too good.
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Old 13.08.2015, 23:46
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Re: Krankenkasse denying sick leave payment

Odile - the op was abroad and the rest of the post treatment costs were covered by her own krankenkasse without much dispute, so her problem really only is the sick leave period at work.
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Old 14.08.2015, 00:54
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Re: Krankenkasse denying sick leave payment

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Odile - the op was abroad and the rest of the post treatment costs were covered by her own krankenkasse without much dispute, so her problem really only is the sick leave period at work.
Oh no, cheap plastic surgery in a foreign country & you think you will get Loss of earnings. Is this a joke?
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Old 14.08.2015, 09:21
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Re: Krankenkasse denying sick leave payment

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Oh no, cheap plastic surgery in a foreign country & you think you will get Loss of earnings. Is this a joke?
Of course she is going to go abroad for plastic surgery - it is incredibly expensive in Switzerland - mostly because the doctors need high wages to buy just the very basics in Migros.
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Old 14.08.2015, 09:35
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Re: Krankenkasse denying sick leave payment

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Well if you have a snowboard accident you also voluntarily choose to do something risky... it's a thin line isn't it?
Err, no. The fine line would be, if you were to remove cover for 'risky' activities, how far outside your front door would you get before you're considered to have voluntarily put yourself at risk.

Or how far out of bed, even
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Old 14.08.2015, 10:02
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Re: Krankenkasse denying sick leave payment

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Err, no. The fine line would be, if you were to remove cover for 'risky' activities, how far outside your front door would you get before you're considered to have voluntarily put yourself at risk.

Or how far out of bed, even
There's some serious accidents that happen in bed as well....
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Old 14.08.2015, 10:38
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Re: Krankenkasse denying sick leave payment

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Oh no, cheap plastic surgery in a foreign country & you think you will get Loss of earnings. Is this a joke?
It seems not...but that could have happened even if she used Swiss specialists...
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Old 14.08.2015, 11:30
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Re: Krankenkasse denying sick leave payment

it might- but it makes a huge difference to insurance if anything goes wrong- but the main point is, was the surgery approved as necessary and the patient referred to a specialist. If the person went to get the op abroad without the approval of her/his doctor and referral- then I believe this will have serious consequences. I feel sorry for your friend, but why should the Swiss system/insurance pay for this? Count yourself lucky the health insurance has paid for putting things right - which probably cost a lot of money, and may continue to do so.
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Old 14.08.2015, 11:37
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Re: Krankenkasse denying sick leave payment

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it might- but it makes a huge difference to insurance if anything goes wrong- but the main point is, was the surgery approved as necessary and the patient referred to a specialist. If the person went to get the op abroad without the approval of her/his doctor and referral- then I believe this will have serious consequences. I feel sorry for your friend, but why should the Swiss system/insurance pay for this? Count yourself lucky the health insurance has paid for putting things right - which probably cost a lot of money, and may continue to do so.
Depending of the type of insurance, of course, in general I think it should be fair to be able to choose a specialist, not necessarily the one your GP is recommending you.
But this surgery wasn't necessary, so this discussion is kind of futile.
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Old 14.08.2015, 11:38
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Re: Krankenkasse denying sick leave payment

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it might- but it makes a huge difference to insurance if anything goes wrong- but the main point is, was the surgery approved as necessary and the patient referred to a specialist. If the person went to get the op abroad without the approval of her/his doctor and referral- then I believe this will have serious consequences. I feel sorry for your friend, but why should the Swiss system/insurance pay for this? Count yourself lucky the health insurance has paid for putting things right - which probably cost a lot of money, and may continue to do so.
Plastic surgery is very rarely 'approved as necessary', I think we are talking about 'enhancements' here
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Old 14.08.2015, 11:43
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Re: Krankenkasse denying sick leave payment

just depends- and we don't know what surgery was performed- but sometimes a psychologist will recommend surgery to boost confidence (I perso disagree, and believe a good psychologist should help someone to love themselves as they are, but ...) if a massive nose, or massive breasts- make life very difficult. A friend of mine had breasts reduced as it was affecting her posture and causing all sorts of real problems.
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